Health Care Reform 2009: No Bill is Better Than a Bad Bill by John Geyman MD

[Better Believe It]

Health Care Reform 2009: No Bill is Better Than a Bad Bill
by John Geyman MD

Dr. John Geyman is professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, a past president of Physicians for a National Health Program and author of “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It.”

------------------------------------


.... this bill is not good enough to pass. It will not make a big enough difference in addressing the three main problems requiring reform–containing the spiraling costs of health care, providing universal access to affordable health care, and improving its quality. If we look at the provisions of this 1,990-page bill concerning just the first two of these three goals, we see that it will fail to deliver real reform.

• Although supporters of the new House bill claim that it would expand coverage for as many as 30 million uninsured, we are actually likely to see an increase in the number of uninsured in coming years for these kinds of reasons—as costs keep going up, many Americans will be forced to drop their present coverage because of inability to afford rapidly rising costs of premiums, deductibles and co-payments; there is no guarantee that the uninsured will be able to afford new private coverage (even with subsidies, which won’t kick in for another four years); and expansion of Medicaid will not take place until 2013 (many states are already pushing back with concerns that the their recession-strained budgets will not allow them to pay their share in adding to their Medicaid programs, potentially leaving millions of the poorest Americans uninsured.

• There are no effective cost containment mechanisms built into the bill, either for the costs of health insurance or for health care itself. As it whines about weakening of the individual mandate that will likely limit some of its big increase in the insurance market, the health insurance industry is already warning that sharp premium increases will result. The most the bill will do is to require disclosure and review of premium increases, without any regulatory teeth. Although the bill would set up a Health Benefits Advisory Committee to recommend a minimal essential benefits package (with four tiers), insurance industry lobbyists will argue for the most minimal levels of coverage, and we can anticipate an exponential growth in underinsurance. Moreover, there are no price controls to be applied anywhere in the system, except perhaps in authorizing the government to negotiate drug prices with manufacturers. But that provision will almost certainly not clear the Senate, where we can expect even less concern for affordability and prices.

• Although the public option has been the target of intense controversy, it will play a negligible role in health care reform. The CBO has concluded that it would cover no more than 6 million Americans, just two percent of the population, in 2013, and will cost more than private programs, mostly due to adverse selection in attracting sicker individuals and its inability to set reimbursement rates for physicians and hospitals as is done by Medicare. Moreover, middle-income families may be required to spend 15 to 18 percent of their income on insurance premiums and co-payments.

• HR 3962 will not result in making health care more affordable, despite allocating some $605 billion over ten years for subsidies to low- and middle-income Americans to buy insurance on Exchanges. We can count on continued increases in the cost of health insurance as far as the eye can see, together with less actuarial value of coverage.

• Buried in the fine print of this monster bill are many provisions that will benefit corporate stakeholders in the medical industrial complex on the backs of patients and their families.


Please read Dr. Geyman's complete article at:

http://pnhp.org/blog/2009/11/05/health-care-reform-2009-no-bill-is-better-than-a-bad-bill/

[emulatorloo]

1. tell that to people with a pre-existing condition, or to those who have had coverage dropped because

they are too sick.

[brentspeak]

12. Maybe you should tell that to everyone who can't afford useless private insurance

[emulatorloo]

19. People who can't afford insurance will get help if the bill passes

If there is no bill, there is only the status quo.

[brentspeak]

43. If there is no bill, insurance CEOs won't get $1 trillion of taxpayer money

and people won't be pushed over the brink with the strain of having to suddenly purchase at least $5,000/year "insurance".

[Better Believe It]

14. You didn't criticize the Senate's 6 month waiting period for pre-existing conditions coverage.

People with pre-existing conditions have a 6 month wait for coverage if the Senate has its way when they go to conference.

I noticed you had nothing critical to say of the Senate plan for a waiting period in the following DU discussion. Why is that?

-----------------------------------

Senate Health Plan: People with pre-existing conditions have a 6 month waiting period for insurance

Democrats' Plan to Help 'Uninsurables' Questioned
ASSOCIATED PRESS
November 5, 2009

WASHINGTON (AP) -- You're afraid your cancer is back, and a health insurance company just turned you down. Under the health care bills in Congress, you could apply for coverage through a new high-risk pool that President Barack Obama promises would immediately start serving patients with pre-existing medical problems. Wait a second. Read the fine print. You may have to be uninsured for six months to qualify.

''If you are a cancer patient and have cancer now, you can't wait six months to go into a plan because your condition can go from bad to death,'' said Stephen Finan, a policy expert with the American Cancer Society Cancer Action Network. He called the waiting period in the Senate bill ''unacceptable.''

Advocates for people with serious health problems, as well as some insurance experts, are raising questions about one of the most important upfront benefits in the Democratic health care legislation: a high-risk pool for the medically uninsurable.

Obama proposed the pool in his September health care speech to Congress. Intended to serve the most vulnerable as a temporary fail-safe, it would stay in place until 2013. That's when insurance companies would be banned from denying coverage because of medical problems. Government subsidies to make coverage more affordable for millions of uninsured would also start that year.

Now, concerns are being raised about the design of the high-risk pools. In addition to the six-month wait, there's a more fundamental issue -- whether $5 billion set aside for the three-year program is enough. The money would be used to help people in poor health pay premiums.

The six-month wait is in the health care bill the Senate Finance Committee approved last month. To qualify for the pool, patients must be turned down for coverage because of a pre-existing condition and uninsured for at least six months.

''If you are somebody with cancer or a heart condition who needs immediate coverage and immediate treatment, that's not very helpful,'' said Karen Pollitz, a Georgetown University health policy professor.

Read the complete article at:

http://www.nytimes.com/aponline/2009/11/05/us/politics/AP-US-Health-Care-Uninsurables.html

[emulatorloo]

17. Per your article, house bill does not have that waiting period

But the House health care bill unveiled last week by Speaker Nancy Pelosi, D-Calif., doesn't include a waiting period. Instead, it would require insurance plans who ''dump'' seriously ill patients to repay the federal pool. ''The House provision will provide immediate relief for people with high-risk conditions who have no alternative for coverage,'' said Finan.

====

The House bill is being voted on today, The Senate bill will get fixed. Baucus remnants will go.


==============

As a side note, I do read any article that comes out of the ASSOCIATED PRESS without a critical eye. They tend to spin things involving Democrats very negatively

"The Associated Press’ Washington bureau chief is Ron Fournier, who’s not only a good buddy of Bush advisor Karl Rove, but very nearly became John McCain’s official press secretary for McCain’s 2008 presidential campaign. (To judge from his articles, he apparently settled for being McCain’s unofficial press secretary.)"

http://firedoglake.com/2009/11/07/come-saturday-morning-tell-us-what-we-dont-know-mr-steele/

[LovinLife]

2. U can always add to a bad bill later. u can't add to nothing tho. nt

[John Q. Citizen]

6. Like No Child Left Behind, or The Iraqi War Resolution. Yeah! Or NAFTA

[Better Believe It]

15. They are doing that right now with really bad amendments! They are making a bad bill worse!

[bluestateguy]

3. And I'm sure the crotchety old professor has great health care and plenty of money in the bank

If we do nothing, HCR is dead for a minimum of four years, and that's only if Obama wins in 2012 (which is unlikely if he comes up empty handed), AND the Democrats maintain large congressional majorities in 2013 (also unlikely regardless of what happens this year; the 2012 and 2014 Senate elections are going to be a bitch).

Instead, we could have another decade or two go by with nothing being done and more people being added to the rolls of the uninsured.

Even during the Clinton boom years the numbers of uninsured either held constant or grew. The status quo must change, even if only very slowly!

[Cha]

4. Just what I was thinking about his

fine health insurance but he still doesn't have a heart.

[emulatorloo]

5. A couple good counter-arguments:What Social Security Teaches Us/The House Public Plan: Yes, It's Wor

EzraKlein:What Social Security Teaches Us About Health Care
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x8738233

The House Public Plan: Yes, It's Worth it
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=103x494214

[Aramchek]

7. some people are OK with over 40,000 people dying each year for no real reason

usually they have good healthcare.

[John Q. Citizen]

9. I have no health care and I see no reason to waste our chance on reform with Romney Care.

but if you think giving more money to private health insurance companies is reform, then go for it.

I know why 40,000 people die each year.

For profit health care is doing the killing.

This bill doesn't address that issue in anyway at all. So thanks, for nothing.

[Aramchek]

20. the passage of this Bill is the death knell of the Insurance Industry

in the Long Run

as its success becomes apparent, the people will grow to demand it, and the Congress will oblige.
and slowly, Big Insurance will suffocate.

[Sebastian Doyle]

21. How the fuck will "big insurance suffocate"

when they were just handed 45 million forced "customers"?

[Aramchek]

22. because they will be forced to have lower rates, profit margins will drop

and insurance companies will shrink

The Public Option will have good prices, Big Insurance won't be able to compete, People will see this, Demand access to the PO,Pressure their Congressmen, and the Plan will be expanded.

It is much, much easier to expand an existing program than to create Medicare for All immediately.
But have no doubts, that is where we're heading.
The Repukes know this. Why don't you?

[Sebastian Doyle]

23. And when exactly would this fairy tale scenario of yours take place?

If we can't get a good bill passed with (theoretically) big majorities in both the House and Senate, how the Hell would we pass it later when the (theoretical) majorities are smaller?

This is the best opportunity we had for REAL reform, and we let a handful of corporate fellating tools destroy it. :evilfrown:

[Aramchek]

24. It is taking place right now. They're about to vote on it.

As I said, it is easier to expand an existing plan, than to pass a perfect one.

You have given up before we even begin.
Civil Rights Reform would have never been achieved if it had been up to the efforts of those who want it all now or nothing at all.

[Sebastian Doyle]

26. And if the DLC would have been in charge of the Civil Rights bill

They would have insisted that a national return to slavery was the best way to achieve equality for everybody.

(Makes about as much fucking sense as mandatory corporate insurance being the best way to REAL health care reform)

[Aramchek]

27. you're fighting a nonexistent enemy. there are very few DLCers here.

and I am most definitely not one of them.

I'm just intelligent enough to comprehend what is really going on here,
and how it will have beneficial repercussions throughout future generations.

[Sebastian Doyle]

28. Whether or not you are a DLC'er, you are buying into their fairy tale

They tell you "oh we know this bill sucks, but let us pass it like it is, and we'll fix it later".

Problem is, they don't ever do that. Which is why NAFTA sucks just as bad now as it did in 1994. And always will, until somebody has the guts to repeal it.

Once everybody is "covered" under corporate false "reform", they will claim the problem is solved, and REAL health care reform will be "off the table" forever.

[Aramchek]

29. the bill is not Single Payer, but it doesn't suck by any means

you want everyone to be allowed to buy into the Public option.
that will happen eventually.

but if it started out like that, it would be virtual single payer.

[Sebastian Doyle]

32. "but if it started out like that, it would be virtual single payer."

And why is that a problem?

Insurance corporations would either clean up their act, or get out of the business. A net win either way.

Anything less than that is rewarding the insurance industry for criminal behavior. Might as well pass a mandatory tax so we can send more money to Goldmine Sucks or Exxon.

[Aramchek]

34. they would most definitely go out of business, and their stocks would plummet.

14% of the Economy would shrivel up without any time for us to adjust to it.

[Sebastian Doyle]

35. Which economy would that be, exactly?

The fictional one that is in "recovery"? The one that doesn't exist outside of Manhattan?

If we switched over to single payer tomorrow, the paper pushers in the insurance companies could do the same thing for the public health care entity. Everyone else would have MORE money, because they would be spending less on health care. Which includes all the employers currently providing coverage.

Sounds like a win for the REAL economy.

[Aramchek]

38. no point in trying to argue this, you are obviously irrational

[Sebastian Doyle]

39. What the fuck ever

"Irrational" = Not buying Wall Street DLC horseshit justification for corporate fellation.

[Aramchek]

40. irrational = thinking Wall Street is a fictional economy

are the job losses from last year's crash fictional?

[Sebastian Doyle]

41. Wall street is a bunch of fucking criminals pushing paper around

They produce NOTHING. They make their money through gambling and theft.

If the economy of this nation depends on them, then it's time to blow the whole goddamn thing up and start completely over.

(and I mean that metaphorically, Agent Mike. Though I wouldn't shed a tear if a plane flew into Goldmine Sucks, if I had to be completely honest about it)

[Raineyb]

33. Like in MA?

Oh that's right, in MA it's actually more expensive and you get less for your money. If you can afford to pay for it.

[Raineyb]

31. Health insurance != health care.

Perhaps your problem is you don't seem able to make the distinction.

[Thrill]

8. Nothing but single payer will make some happy

They fail to realize that its not a reality in this country. Unless there is strong campaign finance reform

[John Q. Citizen]

10. Some people can't grasp that this bill doesn't contain costs. If costs aren't contained peope

will go without needed health care.

So if that's OK with you, then don't contain costs.

You aren't solving the problem here, you are making it worse.


But some people aren't happy unless they are making things worse.

[andym]

13. I think this is an important point, but I think the current bill will control costs

somewhat. It will probably slow the rate of premium increases for a while. However, it would not nearly control costs as well as a public option open to all tied to Medicare rates. Medicare for All or an expansion of Medicare would be even better. The latter could actually freeze costs or bring them down. That is probably not possible with the current proposal.

The reason is clear. Costs are high because of insurance company's profit-based "overhead," the complexity of the payment system, and most importantly increasing charges by the providers themselves and expensive new technologies. The insurance companies have no pressure to resist the increasing costs, since they get more money (windfall profits), even thought their percentage of the take does not increase. The only cost containment they care about is denying claims.

[John Q. Citizen]

16. If you read the article, you will notice that there is an out as far as the percentages of the take

is concerned.

6 million people in the pathetic PO in this bill (by 2019) won't have any effect at all on costs.

There is nothing in this bill that in anyway shape or form will contain costs, except the ability to negotiate drug prices, and that won't last because the White House already bargained that away. It will be stripped out in the Senate and won't be put back in.

Who would make anyone put it back in? Not the cheer leaders in the Democratic Party, that's for sure. They aren't going to exert any pressure on anyone. They all rolled over on the PO, they aren't going to suddenly actually demand negotiations on drug costs.

Without cost containment, there is no universal care, because when we can't afford it they will cut coverage.

[andym]

30. Nevertheless, the bill is projected by the CBO to strongly slow the increase in health cost premiums

as I posted and in disagreement with your qualitative analysis. (But not actually lower then like Medicare for All presumably would have).

Here is an additional CBO document:
http://cbo.gov/ftpdocs/106xx/doc10691/hr3962SubsidiesRangelLtr.pdf
which mentions that by 2016, premiums will be $5,300 for an individual and $15,000 for a family of four in the Exchange.
That compares with the currently projected 24,000 family of 4 premium if nothing is done.

Here is summary of the analysis from Rep Miller:
http://edlabor.house.gov/newsroom/2009/11/cbo-affirms-hr-3962-will-contr.shtml

"November 2, Washington, DC
Today the Congressional Budget Office (CBO) released estimates confirming that H.R. 3962 — the Democratic health reform bill — will succeed in controlling costs that will be reflected in individual and family premiums. CBO found that by 2016, premiums will be $5,300 for an individual and $15,000 for a family of four in the Exchange. This is well below the $24,000 family premium expected if Congress fails to act and premiums grow as projected under current law."

“This underscores that this legislation will control health care costs and lower health care premiums for families and individuals relative to today,” said Chairman Henry A. Waxman, Chairman Charles B. Rangel, and Chairman George Miller. “The Affordable Health Care for America Act will make health insurance and health care accessible for millions of low-income and middle-class families who currently lack affordable coverage.”

A Kaiser/HRET survey found that in 2009, premiums for employer-sponsored coverage are $4,824 for individuals and $13,375 for family policies. Current employer insurance is comparable to the coverage individuals and families will be able to expect in the Exchange with the bill’s insurance reforms and consumer protections in place. One recent projection estimated that health insurance premiums in 2016 will be over $8,000 for individuals and over $24,000 for families if health reform is not enacted."
--------------

Since the 6 million estimate in the PO is also from the CBO, I assume that the author of the article in the OP, would agree with their projected premium costs.

[andym]

11. Campaign finance reform is a start, but it would not be enough

We probably would need a shift to a progressive/liberal economic frame of mind in American culture to get single-payer, or other significant govt-run programs.

[flpoljunkie]

18. PNHP wants single payer. Impossible with the Congress and campaign finance system we have.

[paulk]

25. yes, it's a crap bill, but failure to pass anything will be

even worse, imho. At least passage of this bill indicates that Congress realizes something must be done, that the status quo is not acceptable. If this bill doesn't pan out, something else will be tried, perhaps single payer. If the bill is stopped now by the powers that be, I think it will be a very long time before anything else will come before Congress.

[ej510]

37. Passing this bill doesn't help our nation. Health Insurance

premiums will continue to skyrocket.

[paulk]

42. if that happens, the reform will be seen as a failure

and there will be pressure to try something else. The current situation is unsustainable, and something must be done - Congress needs to act, if only to show that they can act in the face of insurance industry and Republican opposition.

It's a foot in the door, that's all.

[Politicub]

36. So says the good Doctor who has great health care coverage

and has the luxury of waiting for perfection while millions of Americans do not.